Shipper (Principal Party in Interest)
Name: *
Address: *
Address: *
City: *
Country/Territory: *
State/Province: *	(required if US or Canada)
Postal Code: *	(required if US or Canada)
Contact Name:
Contact Telephone: *
E-mail Address:
Export ID No. (EIN):
Parties to Transaction: *	Non Related Related
Date Of Exportation: *	Tuesday, February 09, 2010Wednesday, February 10, 2010Thursday, February 11, 2010Friday, February 12, 2010Saturday, February 13, 2010Sunday, February 14, 2010Monday, February 15, 2010

Ultimate Consignee
Name: *
Address: *
Address:
City: *
Country/Territory: *
State/Province: *	(required if US or Canada)
Postal Code: *	(required if US or Canada)
Contact Name:
Contact Telephone:

Intermediate Consignee
Name:
Address:
Address:
City:
Country/Territory:
State/Province: *	(required if US or Canada)
Postal Code: *	(required if US or Canada)
Contact Name:
Contact Telephone:

Shipment Information
Payor account number: *
Payment Type: *	Prepaid Collect Bill to Third Party
All monetary values will be converted to U.S. dollars on submit.
Insurance Amount:	AEDANGARSAUDAWGAZMBBDBDTBGNBHDBMDBNDBOBBRLBSDCADCDFCHFCLPCNYCOPCRCCZKDKKDOPEEKEGPEURFJDGBPGELGNSGTQGYDHKDHNLHTGHUFIDRILSINRIQDISKJMDJODJPYKESKGSKRWKWDKYDKZTLBPLKRLTLLVLMADMKDMLFMMKMOPMROMURMWKMXNMYRNADNGNNIONOKNPRNZDOMRPENPGKPHPPKRPLNPYGQARRONRUBSARSEKSGDSRDSVCSYPSZLTHBTRYTTDTWDUAHUSDUYUUZSVEFVNDVUVXAFXCDXOFXPFYUMZARZMK
Declared Value:	AEDANGARSAUDAWGAZMBBDBDTBGNBHDBMDBNDBOBBRLBSDCADCDFCHFCLPCNYCOPCRCCZKDKKDOPEEKEGPEURFJDGBPGELGNSGTQGYDHKDHNLHTGHUFIDRILSINRIQDISKJMDJODJPYKESKGSKRWKWDKYDKZTLBPLKRLTLLVLMADMKDMLFMMKMOPMROMURMWKMXNMYRNADNGNNIONOKNPRNZDOMRPENPGKPHPPKRPLNPYGQARRONRUBSARSEKSGDSRDSVCSYPSZLTHBTRYTTDTWDUAHUSDUYUUZSVEFVNDVUVXAFXCDXOFXPFYUMZARZMK
Country(s) of Original Manufacture: *	(required if exporting to Canada)
Hazardous Materials: *	No Yes
Routed Export Transaction: *	No Yes

Third Party Billing Information
Name:
Address:
Address:
City:
Country/Territory:
State/Province: *	(required if US or Canada)
Postal Code: *	(required if US or Canada)

Shipment References
Shipper's Reference:
Consignee's Reference:

Shipment Instructions
Service: *	UPS Express Freight UPS Air Freight Direct UPS Air Freight Consolidated
Direct and Consolidated Options
	Customs Clearance	Door to Door
	Door to Airport	Airport to Door
Delivery Duties (Free Domicile)	Paid (DDP) Unpaid (DDU)
Shipper's Special Instructions

Additional Documents
Attached Documents
	Commercial Invoice	Certificate Of Origin	Packing List
	Banking Sight Draft	Export License	Letter Of Credit
	Dangerous Goods Declaration	Import License
Documents to be Prepare
	Pro Forma Invoice	Consular Invoice	Certificate Of Origin
	Export License	Insurance Certificate	Banking Sight Draft
	Other:
	Other:

If additional item space is necessary to complete this form, please enter the number below:
Number of additional items:

Freight Description
Unit of Measure: *	LB/IN KG/CM	If LB/IN is selected, weights and measures will be converted to metric on submit.
Pieces *	Length *	Width *	Height *	Unit Weight *

Customs Description
D/F	Description	HTS Code	Quantity	Value	Currency	USML Code
D F M					AEDANGARSAUDAWGAZMBBDBDTBGNBHDBMDBNDBOBBRLBSDCADCDFCHFCLPCNYCOPCRCCZKDKKDOPEEKEGPEURFJDGBPGELGNSGTQGYDHKDHNLHTGHUFIDRILSINRIQDISKJMDJODJPYKESKGSKRWKWDKYDKZTLBPLKRLTLLVLMADMKDMLFMMKMOPMROMURMWKMXNMYRNADNGNNIONOKNPRNZDOMRPENPGKPHPPKRPLNPYGQARRONRUBSARSEKSGDSRDSVCSYPSZLTHBTRYTTDTWDUAHUSDUYUUZSVEFVNDVUVXAFXCDXOFXPFYUMZARZMK	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21
D F M					AEDANGARSAUDAWGAZMBBDBDTBGNBHDBMDBNDBOBBRLBSDCADCDFCHFCLPCNYCOPCRCCZKDKKDOPEEKEGPEURFJDGBPGELGNSGTQGYDHKDHNLHTGHUFIDRILSINRIQDISKJMDJODJPYKESKGSKRWKWDKYDKZTLBPLKRLTLLVLMADMKDMLFMMKMOPMROMURMWKMXNMYRNADNGNNIONOKNPRNZDOMRPENPGKPHPPKRPLNPYGQARRONRUBSARSEKSGDSRDSVCSYPSZLTHBTRYTTDTWDUAHUSDUYUUZSVEFVNDVUVXAFXCDXOFXPFYUMZARZMK	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21
D F M					AEDANGARSAUDAWGAZMBBDBDTBGNBHDBMDBNDBOBBRLBSDCADCDFCHFCLPCNYCOPCRCCZKDKKDOPEEKEGPEURFJDGBPGELGNSGTQGYDHKDHNLHTGHUFIDRILSINRIQDISKJMDJODJPYKESKGSKRWKWDKYDKZTLBPLKRLTLLVLMADMKDMLFMMKMOPMROMURMWKMXNMYRNADNGNNIONOKNPRNZDOMRPENPGKPHPPKRPLNPYGQARRONRUBSARSEKSGDSRDSVCSYPSZLTHBTRYTTDTWDUAHUSDUYUUZSVEFVNDVUVXAFXCDXOFXPFYUMZARZMK	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21
D F M					AEDANGARSAUDAWGAZMBBDBDTBGNBHDBMDBNDBOBBRLBSDCADCDFCHFCLPCNYCOPCRCCZKDKKDOPEEKEGPEURFJDGBPGELGNSGTQGYDHKDHNLHTGHUFIDRILSINRIQDISKJMDJODJPYKESKGSKRWKWDKYDKZTLBPLKRLTLLVLMADMKDMLFMMKMOPMROMURMWKMXNMYRNADNGNNIONOKNPRNZDOMRPENPGKPHPPKRPLNPYGQARRONRUBSARSEKSGDSRDSVCSYPSZLTHBTRYTTDTWDUAHUSDUYUUZSVEFVNDVUVXAFXCDXOFXPFYUMZARZMK	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21
D F M					AEDANGARSAUDAWGAZMBBDBDTBGNBHDBMDBNDBOBBRLBSDCADCDFCHFCLPCNYCOPCRCCZKDKKDOPEEKEGPEURFJDGBPGELGNSGTQGYDHKDHNLHTGHUFIDRILSINRIQDISKJMDJODJPYKESKGSKRWKWDKYDKZTLBPLKRLTLLVLMADMKDMLFMMKMOPMROMURMWKMXNMYRNADNGNNIONOKNPRNZDOMRPENPGKPHPPKRPLNPYGQARRONRUBSARSEKSGDSRDSVCSYPSZLTHBTRYTTDTWDUAHUSDUYUUZSVEFVNDVUVXAFXCDXOFXPFYUMZARZMK	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21
All monetary values will be converted to U.S. dollars on submit.
ODTC Unit of Measure:		Barrels/Drums Bags Boxes Bullets/Rounds Bundles Cases Containers Copies Dozen Dozen Pairs Feet Forgings Gallon Grams Gross Gross Containers Gross Line Inches Items Kilograms Kits Line Lots Liters Magazines Man Years Meters Number Other Ounces Packs/Packets Pairs Pallets Pieces Pounds Quarts Roll Sets Sheets Ship Set Squares Systems Tins Tons Tubes Units Visits Wafers Yards
Significant Military Equipment:		No Yes

Authorization
License No/Symbol/NLR	Enter Number or NLR
ECCN
Authorized Officer or Employee
Title or Name for Signature

Terms and Conditions
I accept UPS Supply Chain Solutions' Terms and Conditions *
Would you like to print a copy of the applicable     Shipper's Letter of Instruction Terms and Conditions?	No Yes